Clip Applier With Clip Cartridge Interface

ABSTRACT

A clip applier includes an end effector that is adapted to releasably engage a clip cartridge. The end effector includes spring arms that are deflectable outwardly to receive and retain the clip cartridge within the end effector. The clip applier includes an outer tube that is movable from an advanced position encompassing the end effector to prevent separation of the clip cartridge from the end effector, to a retracted position spaced proximally of the spring arms. In the retracted position, the spring arms can deflect outwardly from the clip cartridge to disengage the clip cartridge from the end effector.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims the benefit of and priority to U.S. Provisional Patent Application Ser. No. 62/958,435, filed on Jan. 8, 2020, the entire content of which is incorporated herein by reference.

FIELD

This technology is generally related to surgical clip appliers and, more particularly, to surgical clip appliers with structure for releasably engaging a clip cartridge.

BACKGROUND

Surgical clip appliers are used to apply ligation clips to body vessels during surgical procedures to occlude or partially occlude the body vessels. Typically, a surgical clip applier includes a handle assembly including a trigger, an elongate body that extends distally from the handle assembly, and a tool assembly supported on the elongate body at a location spaced from the handle assembly. The tool assembly includes jaws that are movable in relation to each other from an open position to receive a ligation clip and subsequently to a clamped position to compress the ligation clip about the body vessel.

Surgical clip appliers include single fire clip appliers and multi-fire clip appliers. Single fire clip appliers use the tool assembly to withdraw a single clip from a clip package to load a single clip into the jaws of the clip applier prior to applying the clip to tissue. Multi-fire clip appliers include a clip cartridge that is coupled to the elongate body of the clip applier. The clip cartridge includes a plurality of ligation clips that are sequentially supplied to the jaws of the clip applier to facilitate placement of multiple clips on a body vessel or on body vessels without withdrawing the clip applier from within a body cavity.

Some multi-fire clip appliers include a clip cartridge that can be removed from the elongate body of the clip applier after use and replaced with a new clip cartridge. These clip appliers are generally complex and expensive to manufacture.

SUMMARY

In aspects, this disclosure generally relates to a clip applier including an end effector that is adapted to releasably engage a clip cartridge. The end effector includes spring arms that are deflectable outwardly to receive the clip cartridge. The spring arms each include an inwardly directed protrusion that is received within a respective recess formed in the clip cartridge to secure the clip cartridge to the end effector. The clip applier includes an outer tube that is movable from an advanced position encompassing the end effector to prevent separation of the clip cartridge from the end effector to a retracted position spaced proximally of the spring arms. In the retracted position, the spring arms can deflect outwardly from the clip cartridge to disengage the clip cartridge from the end effector.

One aspect of the disclosure is directed to a clip applier including a handle assembly, an elongate body, and an end effector. The handle assembly includes a handle body and a movable handle. The handle body defines a stationary handle and a cavity. The elongate body includes an outer tube, an inner shaft, and an actuator rod. The inner shaft includes a proximal end portion and a distal end portion and defines a channel that extends from the handle assembly through the outer tube. The proximal end portion of the inner shaft is secured to the handle body. The actuator rod includes a proximal end portion and a distal end portion and extends from within the cavity of the handle body through the channel. The actuator rod is movable from a retracted position to an advanced position in response to actuation of the movable handle. The outer tube includes a distal end portion and a proximal end portion and is positioned about the inner shaft for movement from a retracted position to an advanced position. The end effector is fixedly supported on the distal end portion of the inner shaft within the outer tube and includes spaced flexible arms that have an inwardly extending protrusion. In its advanced position, the outer tube is positioned about the spaced flexible arms of the end effector to prevent outward deflection of the flexible arms of the end effector and, in its retracted position, the outer tube is moved to a position to allow outward deflection of the spaced flexible arms of the end effector.

Other aspects of the disclosure are directed to a clip applier including a handle assembly, an elongate body, and an end effector. The handle assembly includes a handle body and a movable handle. The handle body defines a stationary handle and a cavity. The elongate body includes an outer tube and an inner shaft. The inner shaft includes a proximal end portion and a distal end portion and defines a channel that extends from the handle assembly through the outer tube. The proximal end portion of the inner shaft is secured to the handle body. The outer tube includes a distal end portion and a proximal end portion and is positioned about the inner shaft for movement from a retracted position to an advanced position. The end effector is fixedly supported on the distal end portion of the inner shaft within the outer tube. The end effector includes spaced flexible arms that each has an inwardly extending protrusion. In its advanced position, the outer tube is positioned about the spaced flexible arms of the end effector to prevent outward deflection of the flexible arms of the end effector and, in its retracted position, the outer tube is moved to a position to allow outward deflection of the spaced flexible arms of the end effector.

Further aspects of the disclosure are directed to a clip applier including a handle assembly, an elongate body, an end effector, a first biasing member, and a second biasing member. The handle assembly includes a handle body and a movable handle. The handle body defines a stationary handle and a cavity. The elongate body includes an outer tube, an inner shaft, and an actuator rod. The inner shaft includes a proximal end portion and a distal end portion and defines a channel that extends from the handle assembly through the outer tube. The proximal end portion of the inner shaft is secured to the handle body. The actuator rod includes a proximal end portion and a distal end portion and extends from within the cavity of the handle body through the channel. The actuator rod is movable from a retracted position to an advanced position in response to actuation of the movable handle. The outer tube includes a distal end portion and a proximal end portion and is positioned about the inner shaft for movement from a retracted position to an advanced position. The end effector is fixedly supported on the distal end portion of the inner shaft within the outer tube and includes spaced flexible arms that have an inwardly extending protrusion. In its advanced position, the outer tube is positioned about the spaced flexible arms of the end effector to prevent outward deflection of the flexible arms of the end effector and, in its retracted position, the outer tube is moved to a position to allow outward deflection of the spaced flexible arms of the end effector. The first biasing member is positioned to urge the outer tube towards its advanced position and the second biasing member is positioned about the proximal end portion of the actuator rod to urge the actuator rod to its retracted position.

In aspects of the disclosure, a biasing member is positioned to urge the outer tube towards the advanced position.

In some aspects of the disclosure, a rotation knob is secured to the proximal end portion of the outer tube and is movable from an advanced position to a retracted position to move the outer tube from its advanced position to its retracted position.

In certain aspects of the disclosure, the biasing member includes a coil spring that is received about the proximal end portion of the inner shaft of the elongate body within the rotation knob.

In aspects of the disclosure, the end effector includes a body formed of a polymeric material, and the spaced flexible arms are formed of spring steel and are secured to the body of the end effector.

In some aspects of the disclosure, the body of the end effector is molded about the spaced flexible arms.

In certain aspects of the disclosure, the end effector includes a body that is monolithically formed with the spaced flexible arms of the end effector.

In aspects of the disclosure, the movable handle includes an engagement member that is positioned within the cavity of the handle body and movable between retracted and advanced positions to move the actuator rod between its advanced and retracted positions.

In some aspects of the disclosure, the engagement member includes an engagement surface and the proximal end portion of the actuator rod includes an abutment member.

In certain aspects of the disclosure, the engagement surface engages the abutment member such that actuation of the movable handle causes movement of the actuator rod from its retracted position to its advanced position.

In aspects of the disclosure, the abutment member is disc-shaped, and the engagement surface is curved.

In some aspects of the disclosure, the engagement member defines a slot and the abutment member includes an oval ring that is received within the slot.

In aspects of the disclosure, the distal end portion of the inner shaft of the elongate body defines a cylindrical cavity and the end effector includes a cylindrical body portion that is received within the cylindrical cavity to secure the end effector to the distal end portion of the inner shaft.

In some aspects of the disclosure, a metal bearing is positioned about the proximal body portion of the end effector within the cylindrical cavity of the inner shaft of the elongate body.

In certain aspects of the disclosure, a biasing member is positioned about the proximal end portion of the actuator rod to urge the actuator rod towards its retracted position.

Other features of the disclosure will be appreciated from the following description.

BRIEF DESCRIPTION OF DRAWINGS

Various aspects of the disclosure are described herein below with reference to the drawings, wherein:

FIG. 1 is a perspective view of exemplary aspects of the disclosed surgical clip applier with an outer of the surgical applier in a retracted position;

FIG. 2 is an exploded view of the surgical clip applier shown in FIG. 1;

FIG. 2A is an enlarged view of the indicated area of detail shown in FIG. 2;

FIG. 2B is a side perspective view of the end effector of the surgical clip applier shown in FIG. 2;

FIG. 3 is a side perspective, partial cross-sectional view of a proximal portion of the surgical clip applier shown in FIG. 1 with a body portion removed;

FIG. 4 is a cross-sectional view taken along section line 4-4 of FIG. 1;

FIG. 5 is a cross-sectional view taken along section line 5-5 of FIG. 4 with the outer tube and a rotation knob of the surgical clip applier in an advanced position;

FIG. 6 is a side perspective view of the end effector of the surgical clip applier shown in FIG. 1 with a clip cartridge spaced from the end effector prior to attachment of the clip cartridge to the end effector;

FIG. 7 is cross-sectional view taken along section line 5-5 of FIG. 4 with the outer tube and the rotation knob of the surgical clip applier in a retracted position;

FIG. 8 is a side cross-sectional view of a distal end portion of the surgical clip applier shown in FIG. 1 as the clip cartridge of FIG. 6 is advanced towards the surgical clip applier;

FIG. 9 is a side cross-sectional view of the distal end portion of the surgical clip applier and the clip cartridge shown in FIG. 8 as the clip cartridge engages the end effector of the surgical clip applier;

FIG. 10 is a side cross-sectional view of the distal end portion of the surgical clip applier and the clip cartridge shown in FIG. 9 with the clip cartridge engaged with the end effector of the surgical clip applier and the outer tube in its advanced position;

FIG. 11 is a cross-sectional view taken along section line 11-11 of FIG. 10;

FIG. 12 is a side perspective view of an alternative end effector of the surgical clip applier shown in FIG. 1;

FIG. 13 is a side cross-sectional view of the distal end portion of the surgical clip applier shown in FIG. 1 and clip cartridge shown in FIG. 6 including the end effector shown in FIG. 12 with the outer tube in its advanced position;

FIG. 14 is a side perspective view of the proximal portion of the surgical clip applier shown in FIG. 1 with a body portion removed and including alternative aspects of the handle assembly; and

FIG. 15 is a cross-sectional view taken along section line 15-15 of FIG. 14.

DETAILED DESCRIPTION

The disclosed surgical clip applier will now be described in detail with reference to the drawings in which like reference numerals designate identical or corresponding elements in each of the several views. However, it is to be understood that aspects of the disclosure included herein are merely exemplary of the disclosure and may be embodied in various forms. Well-known functions or constructions are not described in detail to avoid obscuring the disclosure in unnecessary detail. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the disclosure in virtually any appropriately detailed structure. In addition, directional terms such as front, rear, upper, lower, top, bottom, distal, proximal, and similar terms are used to assist in understanding the description and are not intended to limit the disclosure.

In this description, the term “proximal” is used generally to refer to that portion of the device that is closer to a clinician, while the term “distal” is used generally to refer to that portion of the device that is farther from the clinician. In addition, the term “endoscopic” is used generally to refer to endoscopic, laparoscopic, arthroscopic, and/or any other procedure conducted through a small diameter incision or cannula. Further, the term “clinician” is used generally to refer to medical personnel including doctors, nurses, and support personnel.

FIG. 1 illustrates exemplary aspects of the disclosed clip applier shown generally as clip applier 10. The clip applier 10 includes a handle assembly 12, an elongate body 14, and an end effector 16 that is received within a distal end portion 14 a of the elongate body 14. The handle assembly 12 includes an actuator handle 18 and a handle body 20 defining a stationary handle 22. The handle body 20 includes a distal hub portion 20 a (FIG. 3). Although the handle assembly 12 is illustrated to have a pistol configuration, other handle configurations are envisioned. In the illustrated configuration, the actuator handle 18 is coupled to the handle body 20 and can pivot towards the stationary handle 22 to actuate the clip applier 10 as described in further detail below.

FIG. 2 illustrates an exploded view of the clip applier 10. The handle body 20 includes a first handle body portion 24 and a second handle body portion 26 that are secured together to define the handle body 20. The first and second handle body portions 24, 26, respectively, define a cavity 28 that receives a portion of the actuator handle 18. In aspects of the disclosure, the first and second handle portions 24, 26 are secured together using any one of a variety of securement techniques including welding, screwing, and gluing. The first handle body portion 24 supports a pivot member 30 that is received in a bore 32 of the actuator handle 18 to support the actuator handle 18 for pivoting movement in relation to the stationary handle 22. The portion of the actuator handle 18 received within the cavity 28 of the handle body 20 includes an engagement member 34 that includes a curved engagement surface 34 a. The engagement member 34 moves between retracted and advanced positions within the cavity 24 in response to movement of the actuator handle 18 in relation to the stationary handle 22 through an actuation stroke.

The elongate body 14 includes an inner shaft 39 (FIG. 5), an actuator rod 44, and an outer tube 46. The inner shaft 39 has a proximal end portion and a distal end portion and is formed from a first elongate body portion 40 and a second elongate body portion 42 that are coupled together to define an elongate channel 48 that extends from the handle assembly 12 through the elongate body 14 to the end effector 16. In aspects of the disclosure, the first elongate body portion 40 is formed integrally with the first handle portion 24 and the second elongate body portion 42 is formed integrally with the second handle portion 26. Alternately, the body portions 40, 42 can be formed separately from the handle portions 24, 26 and secured to the handle assembly 12 using known techniques. The first and second elongate body portions 40, 42, respectively, define a cylindrical recess 43 (FIG. 2A) at the distal end portion 14 a (FIG. 1) of the elongate body 14.

FIGS. 3-5 illustrate internal components of the handle assembly 12 including the engagement member 34 of the actuator handle 18 and the actuator rod 44. The actuator rod 44 includes an elongate shaft 50 and a proximal abutment member 52. In aspects of the disclosure, the proximal abutment member 52 of the actuator rod 44 is disc-shaped and is supported within the cavity 28 of the handle assembly 12. Alternately, the proximal abutment portion 52 of the actuator rod 44 can assume a variety of different configurations. The elongate shaft 50 of the actuator rod 44 has a proximal end portion 54 (FIG. 3) and a distal end portion 56. The proximal abutment member 52 is secured to, or formed integrally with, the proximal end portion 54 of the actuator rod 44. The distal end portion 56 of the actuator rod 44 extends through the end effector 16 (FIG. 4). The actuator rod 44 is movable within the elongate channel 48 of the elongate body 14 in response to actuation of the actuator handle 18 between a retracted position (FIG. 4) in which the distal end portion 56 of the actuator rod 44 is positioned within the end effector 16 (FIG. 4) and an advanced position (not shown) in which the distal end portion 56 of the actuator rod 44 extends distally of the end effector 16 into a clip cartridge 102 (FIG. 6).

A biasing member, e.g., a coil spring 60, is received about the proximal end portion 54 of the actuator rod 44 and is positioned to urge the actuator rod 44 towards its retracted position in which the proximal abutment member 52 of the actuator rod 44 is engaged with the engagement surface 34 a of the engagement member 34 of the actuator handle 18. In aspects of the disclosure, the coil spring 60 is positioned between the proximal abutment member 52 of the actuator rod 44 and an inner wall 64 of the handle body 20 to urge the actuator rod 44 in the proximal direction. When the actuator handle 18 is pivoted towards the stationary 22, the engagement member 34 of the actuator handle 18 engages the proximal abutment member 52 of the actuator rod 44 to move the actuator rod 44 from its retracted position towards its advanced position against the bias of the coil spring 60.

The outer tube 46 of the elongate body 14 includes a distal end portion 62 (FIG. 4) and a proximal end portion 63. The proximal end portion 63 of the outer tube 46 is coupled to a rotation knob 66. In some aspects of the disclosure, the proximal end portion 63 of the outer tube 46 includes one or more bores 68 a (FIG. 5) and one or more slots 68 b (FIG. 2) and the rotation knob 66 includes protrusions 70 that are received within the bores 68 a and slots 68 b to axially and rotatably secure the rotation knob 66 to the outer tube 46. The outer tube 46 and the rotation knob 66 are supported about the inner shaft 39 (FIG. 5) and is movable between an advanced position (FIG. 4) and a retracted position (FIGS. 7 and 8). In the advanced position, the outer tube 46 is positioned about and encompasses the end effector 16. In the retracted position, the outer tube 46 is retracted to a position to expose a distal portion of the end effector 16 (FIG. 8) as described in further detail below.

The rotation knob 66 defines a through bore 66 a that receives the proximal end portion 63 of the outer tube 46. A biasing member, e.g., a coil spring 74, is positioned within the through bore 66 a of the rotation knob 66 between the proximal end portion 63 of the outer tube 46 (FIG. 5) and the distal hub portion 20 a of the handle body 20 to urge the rotation knob 66 distally about the inner shaft 39 of the elongate body 14. As described above, the outer tube 46 is secured to the rotation knob 66. Thus, when the rotation knob 66 is urged distally by the biasing member 74 about the inner shaft 39 of the elongate body 14, the outer tube 46 of the elongate body 14 is urged distally about the inner shaft 39 of the elongate body 14 towards its advanced position (FIG. 4).

FIG. 2B illustrates the end effector 16 which includes a body 78 having a central body portion 80, a proximal body portion 82, a distal key portion 84, and a pair of diametrically opposed flexible arms 90. In aspects of the disclosure, the flexible arms 90 are formed of spring steel, the body 78 is formed of a polymeric material, and the flexible arms 90 are secured to the central body portion 80 of the end effector 16 using any of a variety of fastening techniques. In one aspect of the disclosure, the body 78 is molded about the flexible arms 90.

The body 78 of the end effector 16 defines a central through bore 88 that receives the actuator rod 44. The central body portion 80 of the end effector 16 is substantially cylindrical and is received in the distal end portion 62 of the outer tube 46. The central body portion 80 has an outer diameter that is substantially equal to the inner diameter of the outer tube 46 of the elongate body 14. The proximal body portion 82 of the body 78 of the end effector 16 is cylindrical and is received within the cylindrical recess 43 (FIG. 2A) of the inner shaft 39 within the distal end portion 14 a (FIG. 1) of the elongate body 14 to fixedly secure the end effector 16 to the distal end portion of the inner shaft 39. A cylindrical metal bearing 86 is secured about the proximal body portion 82 of the body 78 of the end effector 16. It is noted that in certain aspects of the disclosure, the inner shaft 39 of the elongate body 14 and the end effector 16 are formed from polymeric materials. The metal bearing 86 provides added strength to the connection between the inner shaft 39 and the end effector 16.

The diametrically opposed flexible arms 90 each includes an inwardly extending protrusion 92. In aspects of the disclosure, the protrusions 92 include tapered distal and proximal surfaces that allow the flexible arms 90 of the end effector 16 to be deformed about the clip cartridge 100 to allow the protrusions 92 of the end effector 16 to be received within recesses 106 (FIG. 6) defined within the clip cartridge 100 as described in further detail below.

FIG. 6 illustrates the clip cartridge 100 as the clip cartridge 100 is secured to the end effector 16 of the clip applier 100. The clip cartridge 100 includes a body 102 that supports a plurality of clips (not shown). See U.S. Pat. Nos. 5,354,304 and 5,972,003 for a detailed description of exemplary aspects of a clip cartridge. The clip cartridge 100 includes a proximal body portion including a coupling portion 104. The coupling portion 104 includes recesses 106 that are diametrically opposed to each other and receive the protrusions 92 on the flexible arms 90 of the end effector 16 when the clip cartridge 100 is coupled to the clip applier 10. The coupling portion 104 also defines a transverse slot 108 that receives the distal key portion 84 of the end effector 16 to rotatably secure the clip cartridge 100 onto the end effector 16 when the clip cartridge 100 is coupled to the clip applier 10 (FIG. 1).

FIGS. 7-11 illustrate the clip applier 10 as a clip cartridge 100 is coupled to the end effector 16 of the clip applier 10. When the clip cartridge 100 is coupled to the end effector 16, the rotation knob 66 is pulled proximally towards the handle assembly 12 in the direction of arrows “A” in FIG. 7 against the urging of the biasing member 74 to position the rotation knob 66 about the distal hub portion 20 a of the handle body 20 of the handle assembly 12. As the rotation knob 66 is moved in the direction of arrows “A”, the outer tube 46 is moved from its advanced position (FIG. 4) to its retracted position (FIG. 8) in the direction of arrows “B” in FIG. 8 to expose the flexible arms 90 of the end effector 16. While maintaining the outer tube 46 of the elongate body 14 in its retracted position, the coupling portion 104 of the clip cartridge 100 is moved in the direction of arrows “B” in FIG. 8 between the flexible arms 90 of the end effector 16.

When the coupling portion 104 of the clip cartridge 100 engages the tapered distal surface of the flexible arms 90 of the end effector 16, the flexible arms 90 are deformed outwardly in the direction indicated by arrows “D” in FIG. 9 and pass over the outer surface of the coupling portion 104 of the clip cartridge 100. In aspects of the disclosure, the coupling portion 104 includes flats 110 (FIG. 6) that the flexible arms 90 ride along as the clip cartridge 100 is moved in the direction of arrow “C” in FIGS. 8 and 9 until the protrusions 92 of the flexible arms 90 become aligned with the recesses 106 in the coupling portion 104 of the clip cartridge 100. When the protrusions 92 of the flexible arms 90 become aligned with the recesses 106 in the coupling portion 104 of the clip cartridge 100, the flexible arms 90 snap inwardly in the direction indicated by arrows “E” into the recesses 106 of the clip cartridge 100 to secure the clip cartridge 100 onto the end effector 16 of the clip applier 10. Once the protrusions 92 are received within the recesses 106, the rotation knob 66 (FIG. 7) can be released to allow the coil spring 74 to move the outer tube 46 in the direction of arrows “F” in FIG. 10 back to its advanced position. In its advanced position, the distal end portion 62 of the outer tube 46 is positioned about the flexible arms 90 of the end effector 16 to prevent outward movement of the flexible arms 90 and retain the protrusions 92 of the flexible arms 90 within the recesses 106 of the clip cartridge 100. This prevents separation of the clip cartridge 100 from the end effector 16 to secure the clip cartridge 100 on the clip applier 10. In aspects of the disclosure, the outer tube 46 includes inwardly extending tabs 120 that engage the proximal face 100 a of the clip cartridge 100 when the outer tube 46 is in its advanced position.

FIG. 11 illustrates a cross-sectional view of the clip cartridge 100 secured to the end effector 16 of the clip applier 10. As illustrated, when the clip cartridge 100 is secured to the end effector 16, the distal key portion 84 of the end effector 16 is received in the transverse slot 108 of the clip cartridge 100. Receipt of the distal key portion 84 of the end effector 16 within the transverse slot 108 of the clip cartridge 100 prevents the clip cartridge 100 from rotating in relation to the end effector 100.

FIGS. 12 and 13 illustrate an alternative an end effector of the clip applier 10 which is shown generally as end effector 116. The end effector 116 is substantially the same as the end effector 16 (FIG. 16) except that the flexible arms 190 including the protrusions 192 are integrally and monolithically formed with the body 178 of the end effector 116. In certain aspects of the disclosure, the end effector 116 including the flexible arms 190 is molded from a polymeric material. Alternately, other materials of construction are envisioned including metals, ceramics, or the like.

FIGS. 14 and 15 illustrate an alternative handle assembly of the clip applier 10 shown generally as handle assembly 212. The handle assembly 212 is substantially similar to the handle assembly 12 (FIG. 3) except that the proximal end portion 254 of the actuation rod 244 includes an oval ring 256 and the engagement member 234 of the actuator handle 218 includes a slot 220. The slot 220 receives the oval ring 256 of the actuation rod 244 to prevent the actuation rod 244 from rotating in relation to the actuator handle 218. The actuator handle 218 and actuation rod 244 function in the same manner as the actuation rod 44 and the actuator handle 18 and will not be described in further detail herein.

Persons skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary aspects of the disclosure. It is envisioned that the elements and features illustrated or described in connection with one exemplary embodiment may be combined with the elements and features of another without departing from the scope of the present disclosure. As well, one skilled in the art will appreciate further features and advantages of the disclosure based on the above-described aspects of the disclosure. Accordingly, the disclosure is not to be limited by what has been particularly shown and described, except as indicated by the appended claims. 

What is claimed is:
 1. A clip applier comprising: a handle assembly including a handle body and a movable handle, the handle body defining a stationary handle and a cavity; an elongate body including an outer tube, an inner shaft, and an actuator rod, the inner shaft including a proximal end portion and a distal end portion and defining a channel that extends from the handle assembly through the outer tube, the proximal end portion of the inner shaft secured to the handle body, the actuator rod including a proximal end portion and a distal end portion and extending from within the cavity of the handle body through the channel and movable from a retracted position to an advanced position in response to actuation of the movable handle, the outer tube including a distal end portion and a proximal end portion, the outer tube positioned about the inner shaft and movable from a retracted position to an advanced position; and an end effector fixedly supported on the distal end portion of the inner shaft within the outer tube, the end effector including spaced flexible arms, each of the spaced flexible arms including an inwardly extending protrusion, wherein in its advanced position the outer tube is positioned about the spaced flexible arms of the end effector to prevent outward deflection of the flexible arms of the end effector and, in its retracted position the outer tube is moved to a position to allow outward deflection of the spaced flexible arms of the end effector.
 2. The clip applier of claim 1, further including a biasing member positioned to urge the outer tube towards the advanced position.
 3. The clip applier of claim 2, further including a rotation knob secured to the proximal end portion of the outer tube, the rotation knob movable from an advanced position to a retracted position to move the outer tube from its advanced position to its retracted position.
 4. The clip applier of claim 3, wherein the biasing member includes a coil spring that is received about the proximal end portion of the inner shaft within the rotation knob.
 5. The clip applier of claim 1, wherein the end effector includes a body formed of a polymeric material and the spaced flexible arms are formed of spring steel and are secured to the body of the end effector.
 6. The clip applier of claim 5, wherein the body of the end effector is molded about the spaced flexible arms.
 7. The clip applier of claim 1, wherein the end effector includes a body that is monolithically formed with the spaced flexible arms of the end effector.
 8. The clip applier of claim 1, wherein the movable handle includes an engagement member positioned within the cavity of the handle body and movable between retracted and advanced positions to move the actuator rod between its advanced and retracted positions.
 9. The clip applier of claim 8, wherein the engagement member includes an engagement surface and the proximal end portion of the actuator rod includes an abutment member, the engagement surface engaged with the abutment member such that actuation of the movable handle causes movement of the actuator rod from its retracted position to its advanced position.
 10. The clip applier of claim 9, wherein the abutment member is disc-shaped, and the engagement surface is curved.
 11. The clip applier of claim 9, wherein the engagement member defines a slot and the abutment member includes an oval ring that is received within the slot.
 12. The clip applier of claim 1, wherein the distal end portion of the inner shaft of the elongate body defines a cylindrical cavity and the end effector includes a cylindrical body portion that is received within the cylindrical cavity to secure the end effector to the distal end portion of the inner shaft.
 13. The clip applier of claim 12, further including a metal bearing positioned about the proximal body portion of the end effector within the cylindrical cavity of the inner shaft of the elongate body.
 14. The clip applier of claim 8, further including a biasing member positioned about the proximal end portion of the actuator rod to urge the actuator rod towards its retracted position.
 15. A clip applier comprising: a handle assembly including a handle body and a movable handle, the handle body defining a stationary handle and a cavity; an elongate body including an outer tube and an inner shaft, the inner shaft including a proximal end portion and a distal end portion and defining a channel that extends from the handle assembly through the outer tube, the proximal end portion of the inner shaft secured to the handle body, the outer tube including a distal end portion and a proximal end portion, the outer tube positioned about the inner shaft and movable from a retracted position to an advanced position; and an end effector fixedly supported on the distal end portion of the inner shaft within the outer tube, the end effector including spaced flexible arms, each of the spaced flexible arms including an inwardly extending protrusion, wherein in its advanced position the outer tube is positioned about the spaced flexible arms of the end effector to prevent outward deflection of the flexible arms of the end effector and, in its retracted position the outer tube is moved to a position to allow outward deflection of the spaced flexible arms of the end effector.
 16. The clip applier of claim 15, further including a biasing member positioned to urge the outer tube towards the advanced position.
 17. The clip applier of claim 16, further including a rotation knob secured to the proximal end portion of the outer tube, the rotation knob movable from an advanced position to a retracted position to move the outer tube from its advanced position to its retracted position.
 18. The clip applier of claim 15, wherein the end effector includes a body formed of a polymeric material and the spaced flexible arms are formed of spring steel and are secured to the body of the end effector.
 19. The clip applier of claim 15, wherein the end effector includes a body that is monolithically formed with the spaced flexible arms of the end effector.
 20. A clip applier comprising: a handle assembly including a handle body and a movable handle, the handle body defining a stationary handle and a cavity; an elongate body including an outer tube, an inner shaft, and an actuator rod, the inner shaft including a proximal end portion and a distal end portion and defining a channel that extends from the handle assembly through the outer tube, the proximal end portion of the inner shaft secured to the handle body, the actuator rod including a proximal end portion and a distal end portion and extending from within the cavity of the handle body through the channel and movable from a retracted position to an advanced position in response to actuation of the movable handle, the outer tube including a distal end portion and a proximal end portion, the outer tube positioned about the inner shaft and movable from a retracted position to an advanced position; an end effector fixedly supported on the distal end portion of the inner shaft within the outer tube, the end effector including spaced flexible arms, each of the spaced flexible arms including an inwardly extending protrusion, wherein in its advanced position the outer tube is positioned about the spaced flexible arms of the end effector to prevent outward deflection of the flexible arms of the end effector and, in its retracted position the outer tube is moved to a position to allow outward deflection of the spaced flexible arms of the end effector; a first biasing member positioned to urge the outer tube towards the advanced position; and a second biasing member positioned about the proximal end portion of the actuator rod to urge the actuator rod to its retracted position. 